Case Study: Jessica George
Introduction
This case study will examine and assess Mrs. Jessica George a 79 years old woman who for 15 years has been living with Parkinson’s disease. Mrs. Jessica will be admitted for five days for her respite care where she will seek medical and nursing interventions for the period. For the days of her stay in the facility, a nursing case report will be written to summarize the patient’s diagnosis and interventions and even the discharge arrangement information on the patient. This case report will mainly focus on the identification of the patient’s diagnosis and also give the patient’s pathophysiology which will be derived from the patient’s primary diagnosis that the patient manifests.
On the other hand, the nursing problems arising from the case will also be identified while stipulating the critical intervention and analysis on how they will be solved. Nursing management will also be highlighted in this nursing report which will have the modes of nursing interventions ideal for this specific case study. After this, the report of the case study will also indicate the discharge plan for the patient conducted by a multidisciplinary team. The last thing in the report is the conclusions of the general principles of the report based on the Case Study.
Primary Diagnosis
Mrs. Jessica George has been admitted to Crystal Brook District Hospital after showing worsening symptoms of Perkinson’s diseases which she has been living with for the last 15 years. However, her vital signs are normal and right as she has her blood pressure within the normal range of120/72mmHg, pulse at 82 beats per minute, respirations at 16 breaths per minute. According to Tolosa, Wenning, and Poewe (2006 p.75), Perkinson disease affects motor ability because it is neuro-degenerative. This condition is particularly common with older people who are approaching their 70s. The disease affects the normal functioning of the brain cells within the corpus striatum where the muscle function is significantly affected (Tolosa, Wenning, and Poewe, 2006 p.77). The disease is also prevalent and caused by both environmental and genetic factors (Corti, Lesage, and Brice, 2011 p.1166). Jessica’s mother having died of the same condition, she might have inherited this condition through her genes. The disease occurs when there is a chronic miscommunication between the brain cells and the muscular system due to dopamine levels (Venda et al. 2010 p.563). On the other hand, Pfeiffer (2010 p. 121) underlines that the disease causes one’s gait, facial expressions, voice, handwriting, sense of smell and even movement typically what is seen with Jessica.
The disease might also cause depression to the patient, mood disorders, skin and many others which might affect the patient completely. The secondary symptoms are not as harsh as the primary ones, and this can be explained as to why Mrs. Jessica is still in a position to stand well comfortably. However, she still shows signs of anxiety, lip tremors, and mask-like facial expressions. Her voice is also hoarse, and she drags her leg while walking. Mrs. Jessica is also complaining of constipation and lack of appetite and cough as she takes to water. According to these signs, her Parkinson’s disease is on its third stage as all these symptoms show that its pathogenesis has progressed (Shulman, De Jager, and Feany, 2011 p213).
Nursing Problems
Nursing problems are prone when dealing with patients, and this is still part of nursing management and interventions. According to Abdellah (1957 p4), the nursing problem is common in almost every case. However, it is through the nursing problems that the nurse will be in a position to come up with a working management plan for the patient. The primary nursing problems that will be experienced from Mrs. Jessica’s case is physical movement and her verbal communication as a result of the severity of the disease. According to (Hellqvist & Berterö, 2015 p.94), it is essential for the specialist nurse to be aware of Parkinson’s disease as they attend to their patients.
The first nursing problem to this patient is physical mobility which is caused issues like tremor, bradykinesia, rigidity, and lack of balance and muscular coordination (Azarpaikan, Torbati, and Sohrabi, 2014 p.121). Therefore the goal to this problem to try to maintain the functionality of her motor system for a more extended period. Consequently, the role of the management is to ensure that the patient retains her motor and physical conditions for a more extended period as she age.
On the aspect of her communication due to her hoarse voice and tremor on the lips, there will be enhanced management to ensure that her communication will be improved and better for a longer time. Therefore, through the help of her husband who is her primary caretaker, there will be established help in communication until her own is well developed to a point she can make her communication.
Nursing Management
Several management and interventions will be conducted on Jessica George to help her lessen the symptoms of the disease since it has no cure (Tolosa, Wenning, and Poewe, 2006 p.83). Therefore, the best way to do this is to ensure that the patient is aware of what is happening and also training on how to improve her motor ability. According to Hellqvist & Berterö (2015 p.89), when educating the patients with Parkinson’s disease, it is always healthy to train their spouses to assist them whenever they are with them back at home. Therefore, Frank will also be notified on some of the things to do to help his wife in achieving her ideal motor ability. As a registered nurse, several interventions are required by the patient to be conducted for her to improve physically. The other measure to help the client is through supporting the patient to stand up without holding to the chair. This intervention will help the patient since she has bradykinesia which affects her motor ability. So getting to the chair at first is always a challenge but several attempts will make it easy for the patient to stand without holding on to the chair. The other intervention will see Mrs. Jessica trained how to walk upright by the use of different walking techniques. On the other hand, the patient will be instructed on the significance of exercise which will be conducted daily such as walking, gym cycling and even doing light activities in the garden.
Is will help the muscles to avoid contractures as seen with most victims of Parkinson’s disease. Exercise for a patient of Parkinson’s disease helps a great deal on their motor and cognitive abilities (Petzinger et al. 2013, p. 718). On the other hand, the nurse is supposed to show the essence of hydrotherapy to the patient as it does a lot in helping a person with Parkinson’s disease (Volpe et al. 2014, p. 1212).
On the second problem on the speech and communication impairment, there is a lot to be done on the patient to help them regain their speech fully (Fox et al. 2012, p.23). According to Fox et al. (2012, p.22-24), Parkinson’s disease patients need to have speech therapies to enable them to be in a position to communicate with the other people effectively. Therefore, speech therapy would be advocated for Jessica for her to have her speech back in the ways that she would have her life back on the line. With this, she will be in a position to reduce her frustrations after her failed attempts to make her speech coherent.
Upon admission, the nurse will take charge of her medication where a daily dose of Carbidopa-levodopa will be administered (Pastuma 2015, p.118). The dosage that she has had to reduce the effects of dopamine will also help ensure that her speech and communication is back. Another way to ensure that her speech is not impaired is through ensuring that the patient is devoid of anxiety and frustrations which make the speech worse to the patients with Parkinson’s disease for the five days that she will be in the health facility.
Discharge Planning
After the five days that the patient will be in the hospital, there will need to have a discharge plan which is comprehensive and thorough. This discharge plan should be approved by all the medical practitioners involved in the treatment and management of Mrs. Jessica George. The program will have to include the registered nurse, nutritionists, pharmacists, physician, and pharmacists. The patient will have a health talk conducted to help her in her post-care treatment back at home. With this, the patient will be advised on the form of diet to take to keep her heath at the optimum level. Food rich in fiber and intake of fluids will help her in the prevention of constipation (Rao, Yu, and Fedewa 2015, p.1266).
On the other hand, assurance and hope will be given to her to get over the fear of unknown bearing in mind that the disease has no cure. Therefore, she will be advised to carry on with her daily activities with no doubt and she should always be happy devoid of anxiety and fear (Postuma 2015 p. 125). Therefore the best way to do it is also to talk with her spouse Mr. Frank to even give him details of the post-care treatment that would be required by his wife in the course of her recuperation.
On the other hand, the nurse will seek the physiotherapist to advise the patient on the best post-care measures that will help her get over her illness. With this Mrs. Jessica and her husband will be educated on the essence of being active every time to ensure that her muscular problems will not reoccur (Petzinger et al. 2013, p. 718). To avoid the risk of muscle contractions, there is a need to have exercises conducted and for this to be effective her spouse also need to be educated on how it is done and even its significance (Petzinger et al. 2013, p. 718). On the other hand, the nurse will also involve a nutritionist who will inform Mrs. Jessica about her diet to avoid the issues with constip0ation. On the other side, for her lack of appetitive the physicians would advise on the medication such as multi-vitamin which would boost the patient’s appetite for her to return to her normal diet plans.
On the other hand, the nurse could also speak to the patient and spouse informing them the necessity of following the strict medication schedule without failing in orders for her to be okay. With this, the program will include medication, exercise, therapies and diet plan. With all this, the patient will be assured of an ideal recuperation period and will also be in a position to get over the physical motor and speech impairments. Following this discharge plan will be in a position to recuperate well and also gain her physical motor abilities.
Conclusion
Mrs. Jessica George is a 79 woman who for 15 years has been living with Parkinson’s disease. According to the diagnosis obtained the patient is in the third stage of the disease as she sought for the medical and nursing care and intervention. Therefore, her pathophysiology case report identifies the women from having tremors in the lips, bradykinesia, and spasms affecting her motor abilities. The secondary symptoms that she is experiencing are, for instance, anxiety, depression constipation, and speech problems. Therefore two nursing problems of physical and motor skills and speech impairments become the main nursing problems in need of management. Thus, the two are significant concerns for the registered nurse who will strive to see the patient gain her motor and communication skills and capabilities. The nurse will come with ways to help the patients together with the administration of the medication that has been prescribed. After the nursing, the management of a discharge plan will be adopted by the nurse where will seek assistance from the physiotherapists, nutritionists and the physicians in the bid to educate the patient on her post-care plan.
References
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